To determine the safety of the maximum tolerated dose of human spinal cord-derived neural stem cell transplantation for the treatment of amyotrophic lateral sclerosis (ALS) assessed by the number and severity of adverse events. [ Time Frame: Patients will be followed postoperatively for 24 months. ]

The primary objective of the study is to determine the feasibility, safety, toxicity, and maximum tolerated (safe) dose of human spinal cord-derived neural stem cell transplantation for the treatment of amyotrophic lateral sclerosis (ALS).

The secondary objectives of the study are to evaluate spinal stem cell transplantation therapy in this patient population for: 1) attenuation of motor function loss; 2) maintenance of respiratory capacity; 3) stabilization of ALSFRS-R; 4) reduction of spasticity/rigidity if present; and 5) graft survival at autopsy if and when there is mortality.

There will be 5 sequential cohorts (Groups A-E) with 3 subjects in each cohort. Each cohort will follow a dose escalation plan. New patients will be enrolled into each group. No control group is included. All patients will received spinal cord injections of HSSC.

Have the ability to understand the requirements of the study, provide written informed consent, understand and provide written authorization for the use and disclosure of Protected Health Information (PHI) [per Health Insurance Portability and Accountability Act (HIPAA) Privacy Ruling] and comply with the study procedures.

Subjects with sporadic or familial ALS, meeting the definition of laboratory-supported probable, probable or definite ALS according to the World Federation of Neurology El Escorial Criteria (Appendix A). At the time of enrollment subjects should be within 24 months of symptom onset.

Age 18 years or older.

Females must have a negative serum pregnancy test and practice an acceptable method of contraception or be of non-childbearing potential (post-menopausal for at least 2 years or surgically sterile [hysterectomy, oophorectomy or surgical sterilization]).

Geographic accessibility to the study center and the ability to travel to the clinic for study visits.

Presence of a willing and able caregiver.

Medically able to undergo lumbar and/or cervical laminectomy or laminoplasty as determined by the site Principal Investigator and neurosurgeon.

Medically able to tolerate the immunosuppression regimen consisting of basiliximab, tacrolimus, mycophenolate mofetil, prednisone and methylprednisolone as determined by the site PI.

Agrees to the visit schedule as outlined in the informed consent.

Not taking riluzole (Rilutek®) or on a stable dose for ≥ 30 days.

Vital capacity ≥ 60% of predicted normal for age, height and gender measured in the seated position and ≥50% in supine position during the 7 days prior to surgery.

Ambulatory subjects with extremity weakness and/or spasticity due to ALS. Patients undergoing lumbar surgery must have demonstrable weakness or spasticity in one or both lower extremities. Patients undergoing cervical surgery must have demonstrable weakness or spasticity in one or both upper extremities, with at least antigravity strength. Subjects must have normal neck extensor and flexor strength.

Exclusion Criteria:

Etiology of paraplegia or weakness is due to causes other than ALS.

A positive result on the Panel Reactive Antibody (PRA) test, with the presence of specific HLA antibodies matching the HLA DNA profile of the donor cells.

Any known immunodeficiency syndrome.

Receipt of any investigational drug, device or biologic within 30 days of surgery.

Any concomitant medical disease or condition limiting the safety to participate:

Coagulopathy

Active uncontrolled infection

Hypotension requiring vasopressor therapy

Previous spinal surgery that the neurosurgeon deems to be an obstacle to the planned transplantation

Unstable psychiatric illness including psychosis and untreated major depression within 90 days of screening

Any condition or ALS disease phenotype that the site PI feels may interfere with participation in the study or in the interpretation of study endpoints.

Any condition that the neurosurgeon feels may pose complications for the surgery.

Known hypersensitivity to basiliximab, tacrolimus, mycophenolate mofetil, prednisone or methylprednisolone.

Inability to provide informed consent as determined by the site PI.

Inadequate family or caregiver support as determined by the site PI.

Contacts and Locations

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Please refer to this study by its ClinicalTrials.gov identifier: NCT01730716